DEC 01, 2014
By Anat Galor, MD
Cornea/External Disease
This small, retrospective, multicenter report found that severe adverse effects can occur after extensive cosmetic conjunctival resection for cosmetic eye-whitening.
Subjects included nine patients (17 eyes) who presented with sight-threatening complications 2 to 45 months after a cosmetic eye-whitening procedure involving extensive bulbar conjunctival resection and intra- and postoperative mitomycin C.
The complications included persistent conjunctival epithelial defects (16/17 eyes) which were very difficult to treat, limbal stem cell compromise (4 eyes of 2 patients), infectious scleritis (3 eyes of 3 patients), scleral ulcers (5 eyes of 3 patients), uveitis (3 eyes of 2 patients) and infectious endophthalmitis (1 eye).
They write that the combination of excessive resection of conjunctival tissue, scleral ischemia from aggressive cauterization of the sclera vessels, and the use of MMC and topical NSAIDs likely leads to a very unstable epithelial surface and impaired wound healing on bare sclera. As a result, recurrent and persistent epithelial defects occur, which increase the risk of secondary infection, scleral inflammation and melt. If a postoperative patient with early symptoms is encountered, the physician should be aggressive to treat the ocular surface and prevent further breakdown. Any nonhealing ulcers should be cultured and treated appropriately.
They conclude that while this is not a commonly performed procedure, it is important for patients and physicians to be aware of the serious side effects associated with it. Because of the many potential severe sight-threatening complications from this cosmetic procedure, it appears that the risks outweigh the benefits.